Will temporary phone-consult billing codes ever be made permanent?

At the beginning of October, in recognition of the strain that this fall's return of the H1N1 flu would put on its physicians, British Columbia offered the medical community a gift: PG13705. That's the billing code that pays doctors $14.74 for dispensing advice on the pandemic flu to their patients via telephone.

The fee has proven popular. In the first month it was made available to doctors, the provincial insurance plan paid 16,785 claims for PG13705. That's a quarter of a million dollars for that billing code alone, and that was largely before the H1N1 flu really came surging back around the beginning of November.

But just as the government giveth, the government can taketh away. When it's decided it's no longer needed to support doctors dealing with flu patients, PG13705 will disappear "at the declaration of the Provincial Health Officer."

I asked Dr Bonnie Henry, the BC Centre for Disease Control’s director of Public Health Emergency Management, about health administrators' take on the future of paid phone consults. She was one of the people who recommended the creation of PG13705, and although she wasn't ready to recommend that phone consults become permanent features of the billing structure, she didn't rule out the idea. My interview with her appeared in the November issue of Parkhurst Exchange magazine.

PARKHURST EXCHANGE: Logic would say that if having a billing code for phone consults works during a pandemic to deal with people coming in with infectious diseases, wouldn’t it also work not during a pandemic?
BONNIE HENRY: Maybe. [Laughs] I don’t know about that. We would have to look at it how it would be used. But I do think for getting through this it’s a very important piece to help us manage this without putting clinicians at risk.
PE: I ask because I think many physicians would like to have the option to bill for phone calls occasionally.
BH: Yeah, and we do so much by phone we don’t get paid for. Look at lawyers, for example. Talk to your lawyer for ten minutes on the phone and you get billed for it. [Laughs] But, you know, part of it is built into other fee codes. I think there’s a lot of potential for abuse, but clinicians are professionals and should be trusted to use things appropriately. I’m a little on the fence. I do know that this time I was one of the people that advocated for this because we know there are going to be a lot more people infected than usual with influenza this year, and this is one really important strategy to help clinicians be able to cope with that and to help protect our communities.

Ontario followed suit at the end of last month, creating three new fee codes for phone consults: K080, K081 and K082. K080 refers to health-advice calls of 10 minutes or less, and pays $11.00. K081 refers to health-advice calls of longer durations, or to mental health consults of 10-16 minutes, and pays $27.55. K082 refers to half-hour mental health consults, and pays $55.05 per half hour.

One thing that distinguishes the Ontario fee codes from BC's PG13705 is that the Ontario codes aren't restricted to use for H1N1 flu patients, which gives doctors more flexibility in deciding how to run their practice. For instance, a family physician whose waiting room is teeming with suspected influenza cases might decide it's safer to speak to non-urgent flu-free patients by phone, if their care can be reasonably delivered that way. In a statement on November 2, OMA President Dr Suzanne Strasberg explained that the new codes are "designed to alleviate some of the pressures on the health care system. The intent is for doctors to confer with patients over the phone thereby reducing the contact between patients who have the flu and those who do not, while still being able to speak with their doctor about other health concerns."

Ontario physicians were also able to bill for phone consults during the 2003 Toronto SARS outbreak. At the moment, the Ontario Medical Association's current contract with the provincial government doesn't include any permanent fee codes for phone consults, and the mandate for the next set of negotiations hasn't been established yet. K080, K081 and K082 are all temporary codes, like BC's PG13705, and will expire either at the Minister of Health's discretion or after twelve months.

The British Columbia Medical Association begins negotiations in a few months on a collective agreement to replace the current one, which expires March 31, 2012. Although the union and other physicians' groups have asked the government for a permanent phone-consult billing code in the past, Canadian Medicine is told that, at the moment, the BCMA's tariff committee has "no plans at this time to do that" in its upcoming negotiations.

Is there are any chance one or more of the provincial governments might see how useful the phone consults are proving to be and decide to keep them permanently in a limited capacity -- perhaps similar to the current usage, in which the consults will only be compensated when there's a safety reason not to bring a patient into your office?

That remains to be seen.

UPDATE, Dec. 2: Canadian Medicine neglected to mention that Alberta also introduced a special H1N1-flu-related phone-consult billing code this fall, on October 30. Theirs is numbered 03.01AD and pays $20. More information on the Alberta fee code is available here.

Photo: Shutterstock

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